David Wilder

Rates of dementia in three ethnoracial groups

Rates of dementia may vary among ethnoracial groups. Any real and substantial such difference would merit serious attention by health planners, clinicians and those seeking to advance our understanding of the etiology of this group of disorders.

Item bias in cognitive screening measures: Comparisons of elderly white, Afro-American, Hispanic and high and low education subgroups

A study of item bias in standard cognitive screening measures was conducted in a sample of Afro-American, Hispanic and non-Hispanic white elderly respondents who were part of a dementia case registry study. The methods of item-response theory were applied to identify biased items. Both cross-cultural and high and low education groups were examined to determine which items were biased. Out of 50 cognitive items examined from six widely used cognitive screening measures, 16 were identified as biased for either high and low education groups or ethnic/racial group membership.

Operating Characteristics of Brief Screens for Dementia in a Multicultural Population

Operating characteristics of seven screens for dementia were compared across various groups for 795 persons who had received a criterion diagnostic evaluation. Area under the curve (AUC), based on receiver operating characteristics, was compared between and within scales as an indication of their efficiency. Differences in AUC were only 5% across all the scales for the entire sample, but increased to 11% across sociocultural groups and scales and to 20% across education groups and scales. Two scales (the Mini-Mental State Exam and the Short Portable Mental Status Questionnaire) misclassified most nondementias for the entire sample, and all scales misclassified most nondementias among persons with less than 5 years of education. Findings could support a recommendation that certain shorter scales be used because they perform as well as longer ones, are more consistent across cultural and educational groups, and can be more easily modified to improve performance in culturally diverse populations.

Consistency of clinical diagnosis in a community-based longitudinal study of dementia and Alzheimer's disease

We evaluated the consistency of the diagnosis of dementia in a multicultural, longitudinal community-based study of cognitive impairment and dementia. We diagnosed dementia using a fixed neuropsychological paradigm; the diagnosis also required historical evidence of functional impairment. In a sample of 656 subjects with at least one annual follow-up examination, dementia was confirmed at 1 year in 89% of the 304 subjects initially demented, and in 90% of the 136 subjects with the initial diagnosis of probable Alzheimers disease (AD). The 34 initially demented subjects who failed to meet criteria for dementia at follow-up included 13 with an initial diagnosis of probable AD. All 34 still had evidence of cognitive impairment; this group was more likely to have a history of pulmonary disease, multiple medication use, or chronic alcohol use than other demented patients. Consistency of dementia diagnosis did not vary according to educational attainment or ethnic background. The use of a neuropsychological paradigm such as ours in large longitudinal studies of dementia may minimize interobserver diagnostic variability or diagnostic drift over time while contributing the benefits of a comprehensive cognitive evaluation to the diagnostic process. NEUROLOGY 1995;45: 2159-2164

Concepts of Depression in the Elderly: Signposts to Future Mental Health Needs

A broad and reliable diagnosis of “pervasive depression” was used in the U.S.-U.K. Geriatric Community Study. The great majority of these cases were judged to be in need of psychiatric intervention and were heavy users of health services, but interventions for their psychiatric problems were mostly from medical practitioners.

A flexible system of detection for Alzheimer’s disease and related dementias

Brief methods for detecting Alzheimer’s disease and related dementias (ADRD) are widely used in epidemiological and clinical research, and, increasingly, for clinical purposes in health care settings, such as primary medical care and geriatric evaluation and management (GEM) units. There are many instruments from which to choose for these purposes, but they have generally been developed in isolation. Little is known about the gains in precision (incremental validity) from using more than one instrument in an integrated manner in the process of detection, nor has there been a systematic evaluation of the usefulness of being able to choose from a repertoire of instruments to suit specific screening contexts. The key characteristics of the techniques featured here, namely, brevity and ease of administration, allow such assessments to find a place in many different contexts. This paper presents findings supporting specific recommendations for a limited battery of brief screening techniques for detection of dementia, that can be tailored, standing alone or in combinations, to optimally suit particular requirements of (i) precision, or (ii) style of administration. (Aging Clin. Exp. Res. 7: 165-172, 1995)

The human element in survey research.

This paper addresses itself to issues related to data collection in survey research with a community population. Areas discussed relate to practical human problems in conducting a community survey of a stratified random sample of people sixty-five years of age and over in New York City. Some of these problems occur in most large scale community surveys, but some are a result of special features of this particular study. Topics covered include difficulties encountered in obtaining interviews, maintaining the staff, and coordinating the research team in the ongoing U.S.-U.K. Cross-National Project.